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ADHD AND COLLEGE RELATIONSHIPS 1
ADHD Symptom Levels and Romantic Relationship Quality in Emerging Adults
Michael R. Bruner, Amanda D. Kuryluk, and Sarah W. Whitton
University of Cincinnati
This paper, in final edited form, was published as:
Bruner, M. R., Kuryluk, A. D., & Whitton, S. W. (2015). ADHD symptom levels and romantic
relationship quality in emerging adults. Journal of American College Health, 63, 98-108
ADHD AND COLLEGE RELATIONSHIPS 2
Abstract
Objective. The purpose of this study was to examine whether ADHD symptom levels in college
undergraduates are associated with poorer romantic relationship quality, and to test whether
emotion regulation difficulties, perceived stress, and hostile relationship conflict mediate this
association.
Participants. The sample consisted of 189 undergraduate students ages 18 to 25.
Methods. Self-report measures of ADHD symptoms, relationship quality, and the proposed
mediators were collected via online survey from May through August of 2011.
Results. Participants who reported clinically significant levels of both hyperactivity-impulsivity
and inattentiveness (consistent with ADHD-C) had lower relationship quality than those whose
self-reported symptoms indicated no ADHD diagnosis. Further, for women only, both
hyperactive/impulsive and inattentive symptom levels were negatively associated with
relationship quality. Emotion regulation problems and hostile relationship conflict mediated this
association.
Conclusion. Findings suggest that ADHD impairs relationship quality among young adults, and
suggest mechanisms through which this impairment might occur.
ADHD AND COLLEGE RELATIONSHIPS 3
ADHD Symptom Levels and Romantic Relationship Quality in College Students
Attention-Deficit/Hyperactivity Disorder (ADHD) is a psychiatric condition
characterized by inattention and/or hyperactivity-impulsivity.1 There are three diagnostic
subtypes of ADHD: Predominantly Inattentive Type (ADHD-IA), Predominately Hyperactive-
Impulsive Type (ADHD-HI), and Combined Type (ADHD-C).1 Though usually considered a
childhood disorder, 2-8% of young adult college students report clinically significant levels of
ADHD symptoms.2 Because the salient developmental tasks of this life stage are achieving
work/educational goals and establishing romantic partnerships,3 understanding the impact of
ADHD symptoms on college students requires attention to these two life domains.
A sizeable literature has documented associations between ADHD and impaired
academic functioning.2 In contrast, links between ADHD and romantic relationship functioning
among young adults are not as well studied. A few studies have documented deficits in more
general interpersonal functioning among university students. For example, ADHD symptoms
have been associated with less liking and greater social rejection by peers.4 There is also
evidence that male undergraduates with ADHD-IA, although not those with ADHD-HI or
ADHD-C, begin dating at a later age, have fewer romantic relationships, and are more likely to
experience opposite-sex rejection than undergraduate men with no ADHD diagnosis.5 Similarly,
young adult women diagnosed with ADHD in childhood engage in fewer romantic relationships
than those without ADHD.6
Once young adults with ADHD do enter into romantic relationships, however, it is
unclear whether those relationships are at greater risk for dysfunction. Married adults with
ADHD have a higher frequency of divorce than adults without ADHD,7
and clinicians have
reported anecdotally that marital problems are one of the most common presenting problems of
ADHD AND COLLEGE RELATIONSHIPS 4
adults seeking treatment for ADHD.8 To our knowledge, however, only three studies have
investigated links between ADHD and relationship difficulties in unmarried, college-aged adults.
In one study, 38 young women who had been diagnosed with ADHD as children and 24
community controls without a history of ADHD were compared on romantic relationship
impairment (operationalized as self- and parent-responses to one item capturing degree of
“current problems” with romantic relationships).6 No differences were observed between groups.
Similarly, in a sample of 77 undergraduate men in dating relationships, relationship satisfaction
did not differ between men with ADHD-IA, ADHD-C, and no ADHD diagnosis.9 The relatively
small sample size in both of these studies, however, may have limited the ability to detect
effects. The third study differed from the first two in that it examined ADHD symptom levels
rather than diagnostic groups and used a much larger sample of 517 college students.10
In this
study, symptoms of inattention and symptoms of hyperactivity-impulsivity each showed small
but significant negative correlations with relationship satisfaction (rs = -.18 and -.13,
respectively, ps<.01).10
When self-reported symptoms were used to categorize students as
ADHD-IA, ADHD-HI, or ADHD-C, however, there were no significant differences between
diagnostic groups.
In sum, research exploring the potential negative effects of ADHD on romantic
relationship functioning among college students and other young adults is scarce, and findings
are inconsistent. Further, insufficient attention has been paid to potential gender differences in
associations between ADHD and relationship functioning. Because interpersonal relations are,
on average, more central to women’s than men’s identities and self-concepts,11
romantic
relationships are theorized to be more strongly associated with women’s than men’s mental
health. Both depressive symptoms and general psychological distress are more strongly
ADHD AND COLLEGE RELATIONSHIPS 5
associated with marital satisfaction12,13
and college dating relationship satisfaction14
for women
than for men. Most previous studies of ADHD and relationship functioning have either examined
samples of one gender6,9
or have not examined gender differences.15,16
In the one exception,
researchers found similar associations between ADHD symptoms and relationship satisfaction
for college men and women.10
Further study is needed to determine if gender differences exist.
Potential Mechanisms Relating ADHD Symptoms and Relationship Satisfaction
It is important not only to determine whether adults with ADHD have poorer quality
relationships, but also to explore why this might be the case. Finding mechanisms through which
ADHD symptoms might influence relationship satisfaction will help build a theoretical
understanding of the association, directing future research and identifying targets for clinical
interventions. To our knowledge, however, no research has yet attempted to identify factors that
may mediate the association between ADHD and relationship dysfunction. Given evidence that
individuals with ADHD exhibit more emotion regulation difficulties,17,18
report higher levels of
stress,19
and experience more interpersonal conflict20,21
than those without ADHD, these factors
may help explain any associations between ADHD and relationship quality.
Emotion regulation is a multi-dimensional construct that encompasses affect recognition,
emotional control, and the ability to refrain from impulsive behavior when experiencing intense
emotions.22
Individuals with ADHD demonstrate poorer affect recognition, greater emotional
intensity, and more emotional impulsivity than those without ADHD,23,24
possibly contributing
to poor relationship quality. Adults with poor emotion regulation skills frequently report
difficulties in their romantic relationships,25
and couple-based treatments for severe emotion
dysregulation in one partner generally improve the other partner’s relationship satisfaction.26
Adults with ADHD also tend to report higher levels of perceived stress than do those
ADHD AND COLLEGE RELATIONSHIPS 6
without ADHD.27
Among college students, ADHD symptoms have been associated with higher
levels of self-reported stressors in many areas of life, including time pressures, academics,
friendships, and romantic relationships.10
According to major models of marriage and couple
relationships, such stressors represent significant risk factors for relationship distress and break-
up.28,29
Therefore, the negative association between ADHD symptoms and relationship quality
may be partially mediated by perceived stress.
ADHD has also, among adolescents, been linked with more frequent and more hostile
conflict with loved ones such as parents,30
including higher levels of verbal aggression and
anger.31
Because hostility expressed toward parents in adolescence is highly predictive of
hostility expressed towards romantic partners in adulthood,32
it is likely that young adults with
ADHD show elevated levels of hostile conflict with their dating partners. Given that hostile
couple conflict is a well-established predictor of marital distress and divorce,33
an association
between ADHD symptoms and relationship satisfaction in college students might be accounted
for by elevated hostile relationship conflict.
The Current Study
In the current study, we sought to build knowledge about how ADHD may affect the
romantic relationships of undergraduate college students. First, we aimed to replicate the
findings of the one study that found significant associations between ADHD symptom levels and
romantic relationship satisfaction.10
This strategy, which involves assessing self-reported ADHD
symptom levels rather than ADHD diagnoses based on full clinical evaluations, has several
advantages. Specifically, it captures the full continuum of individual differences in ADHD
symptom levels, allows for a larger sample size (given the lower cost and subject burden
associated with self-report measures vs. clinical evaluations) and provides greater power to
ADHD AND COLLEGE RELATIONSHIPS 7
detect small associations between ADHD and romantic relationship variables.10
We evaluated
associations of relationship satisfaction with hyperactive-impulsive symptoms and inattentive
symptoms separately, given the differences in dating activities that have been observed between
undergraduate men with different diagnostic subtypes of ADHD.5 Further, to facilitate
comparison with other previous studies, we also tested for group differences in relationship
satisfaction between individuals who report symptom levels consistent with each of the three
diagnostic subtypes of ADHD. Second, the present study was designed to extend previous
research in two ways: (1) assessing for potential gender differences in the association between
ADHD and relationship quality, which have been largely overlooked in existing studies, and (2)
exploring how ADHD symptoms may negatively influence romantic relationship quality by
assessing three potential mediators of this association: difficulties in emotion regulation,
perceived stress, and hostile conflict in the relationship.
Method
Participants & Procedure
Participants were 189 (73 male, 116 female) undergraduate students who volunteered to
complete an IRB approved on-line study of dating relationships to fulfill requirements for
psychology courses at a large Midwestern university. Inclusion criteria were an age of 18-25
years and current involvement in a romantic relationship of at least 3 months duration. The
participants were predominantly White (87%; 6% African American, 3% Asian, 3% multiracial,
2% Hispanic/Latino). Mean age was 19.58 (SD = 1.38). Over half were first years (54%), 26%
were sophomores, 10% were juniors, 10% were seniors, and 1% had graduated but were taking
additional courses. Almost half (46%) of the sample reported a parental income of $70,000 or
more and 13% reported a parental income of less than $30,000; median parental income fell into
ADHD AND COLLEGE RELATIONSHIPS 8
the $60,000 - $69,999 range. Participants were in their current relationship for an average of
18.59 (SD = 14.35) months. The majority (72%) considered themselves to be dating exclusively;
10% were dating casually, 13% were dating regularly, 4% were engaged, and 2% were married
or in a domestic partnership. Twelve percent were cohabiting, and 2% had children from either a
current or past relationship. Two percent were dating a partner of the same sex. Finally, based on
self-reported symptom level, 23% of the sample fell into the ADHD-IA group, 12% fell into the
ADHD-HI group, 21% fell into the ADHD-C group, and 44% fell into the no-ADHD group.
Participants completed a password-protected online survey containing an informed
consent document and self-report measures of a variety of personal and relationship
characteristics. Only measures relevant to the present hypotheses are described in this paper.
Measures
Relationship status and length. A basic demographic information form included items
to assess relationship status and relationship length in months.
ADHD Symptoms. ADHD symptoms were measured using the Adult ADHD Self-
Report Scale (ASRS),34
an 18-item scale based on the DSM-IV criteria for ADHD designed to
identify individuals at risk for ADHD. Participants rate their experience of each of the DSM-IV’s
nine symptoms of inattentiveness and nine symptoms of hyperactivity-impulsivity in the last 6
months on a 5-point Likert scale (0 = never; 4 = very often). Responses to all 18 items are
summed for a global measure of ADHD symptom severity. Subscale scores were calculated by
summing the items for inattentiveness (IA) and hyperactivity-impulsivity (HI). The ASRS has
good reliability and validity in both clinical and community samples.35
In the current study,
internal consistency (Cronbach’s alpha) was .80 for the inattentiveness subscale, .78 for the
hyperactivity-impulsivity subscale, and .86 for the full scale.
ADHD AND COLLEGE RELATIONSHIPS 9
Consistent with strategies used in previous research,10
participants were classified into
one of three subclinical ADHD presentations corresponding to the three ADHD subtypes defined
by the DSM-IV-TR: Primarily Inattentive (ADHD-IA), Primarily Hyperactive/Impulsive
(ADHD-HI), or Combined Type (ADHD-C). Scores above 16 on either of the ASRS subscales
indicate a likelihood of having ADHD,36
so we used this cutoff score to categorize participants
into the ADHD-IA or ADHD-HI groups. Participants who scored above 16 on both subscales
were categorized as ADHD-C, and participants who did not meet the cutoff on either subscale
made up a control (no ADHD) group.
Relationship Satisfaction. Using the 16-item Couples Satisfaction Index (CSI-16),37
participants evaluated their romantic relationship on 6- and 7- point Likert-type scales, and
described their relationship on a bipolar adjective scale for each of six characteristics (e.g., 0 =
miserable, 5 = enjoyable). All ratings were summed; higher scores indicate greater satisfaction.
The CSI-16 has demonstrated good reliability and validity with college age dating
relationships.37
In this sample, internal consistency was excellent (α = .95).
Emotion Regulation Problems. Participants completed the Difficulties in Emotion
Regulation Scale (DERS),22
a 36 item measure that captures difficulties in six dimensions of
emotion regulation, including lack of awareness, clarity, and acceptance of emotional responses;
difficulties with impulse control and goal-directed behavior when experiencing negative
emotions; and limited effective emotion regulation strategies. Each item states an emotion
regulation difficulty (e.g., “When I’m upset, I feel out of control”) and is rated on a 5-point scale
(1 = almost never; 5 = almost always). Scores are summed to create an index of total emotion
regulation problems. The DERS has demonstrated evidence of reliability and validity.22
In this
sample, internal consistency was excellent (α = .94).
ADHD AND COLLEGE RELATIONSHIPS 10
Perceived Stress. Participants completed the 10-item Perceived Stress Scale (PSS),38
a
self-report measure that captures the degree to which situations in one’s life are considered
stressful on a 5-point scale (0 = never; 4 = very often). Responses to all items are summed. The
PSS has shown good validity and reliability.39
In the present sample, internal consistency was
very good (α = .85).
Hostile Relationship Conflict. Using the eight-item Negative Conflict scale of the
Communication Skills Test,40
participants rated the frequency of negative relationship conflict
events, including withdrawal, negative escalation, and invalidation, on a 7-point scale (1 =
Never; 7 = Most of the time). Mean response across items represent participants’ relationship
conflict scores. The subscale has shown internal consistency and evidence of validity.41
In the
present sample, internal consistency was high (α = .89).
Results
Means and standard deviations are presented separately for men and women in Table 1.
Zero-order correlations are presented separately for men and women in Table 2.
Associations between ADHD Symptoms and Relationship Quality
To test whether ADHD symptoms were associated with relationship quality, we first
calculated zero-order correlations between CSI scores and the hyperactive, inattentive, and total
symptom scores from the ASRS. Contrary to hypotheses, for the full sample, relationship
satisfaction was not associated with any of the three ADHD symptom scores (r = -.12, p = .10 for
hyperactive-impulsive; r = -.12, p = .11 for inattentive; r = -.13, p = .07 for total symptoms; not
displayed in table). Running correlations separately by gender, however, revealed that
relationship satisfaction was negatively associated with all three ADHD symptom variables for
women (see Table 2). It was not significantly correlated with any of the ADHD variables for
ADHD AND COLLEGE RELATIONSHIPS 11
men. Therefore, our first hypothesis was supported for women only; compared to women with
fewer ADHD symptoms, those with more symptoms reported less romantic relationship
satisfaction. Despite this finding, a Fisher r-to-z transformation showed that the correlation did
not significantly differ by gender (z = 1.82, p = .07), suggesting that ADHD symptoms are not
more strongly linked with relationship satisfaction for women than for men.
Second, we assessed group differences in relationship satisfaction among the three
subclinical ADHD presentations (ADHD-C, ADHD-IA, and ADHD-HI) and the no-ADHD
group. First, we ran a 4 (ADHD group) x 2 (gender) analysis of variance (ANOVA) predicting
relationship satisfaction scores. There was no interaction between ADHD group and gender,
indicating that results were consistent across men and women. Therefore, for simplicity, we
present group means collapsing across gender (see Table 3, top row). A one-way ANOVA
predicting relationship satisfaction with ADHD type indicated significant group differences for
relationship satisfaction. Post hoc analysis using the LSD post hoc criterion for significance
indicated that relationship satisfaction was higher for those without ADHD than for those with
ADHD-C (Cohen’s d = .57, medium effect). There were no other differences between groups.
Associations between ADHD Symptoms and Emotion Regulation Problems, Stress, and
Hostile Relationship Conflict
We evaluated whether ADHD symptom levels were associated with the proposed
mediators first by examining correlations between variables (See Table 2). As hypothesized, for
both men and women, higher ADHD symptoms (hyperactive-impulsive, inattentive, and total)
showed moderate positive associations with emotion regulation difficulties and with perceived
stress scores. Fischer’s r to z comparisons indicated that the magnitude of these correlations did
not differ by gender, and dependent correlation comparisons indicated that they did not differ by
ADHD AND COLLEGE RELATIONSHIPS 12
ADHD symptom subtype. All ADHD symptom variables showed expected positive correlations
with hostile conflict for women; in contrast, for men, only hyperactive-impulsive symptoms were
associated with hostile relationship conflict.
Second, we tested for group differences in the three proposed mediators among the four
types of subclinical ADHD presentations. Results of initial 4 (ADHD group) x 2 (gender)
ANOVAs predicting each proposed mediator indicated that there was no interaction between
ADHD group and gender. The results can therefore be assumed to be consistent across young
adult men and women. For simplicity, we present group means collapsing across gender (see
Table 3) and ran one-way ANOVAs predicting each potential mediator (emotion regulation
difficulties, perceived stress, and hostile relationship conflict) with ADHD type as the
independent variable. As shown in Table 3, there were significant group differences for all three
mediators. Post hoc analyses using the LSD post hoc criterion for significance indicated that the
ADHD-IA and ADHD-C groups had higher average emotion regulation difficulties than the no-
ADHD group (d = .61 and d = 1.05, medium and large effects, respectively) and higher
perceived stress than the no-ADHD group (d = .74 and d = .98, medium and large effects,
respectively). In addition, participants with ADHD-C reported more emotion regulation
difficulties than those with ADHD-HI (d = .56, medium effect), and those with ADHD-IA and
ADHD-C had higher perceived stress than those with ADHD-HI (d = .53 and d = .77,
respectively; both medium effects,). Finally, all three diagnostic groups had higher mean couple
conflict than the no-ADHD group (d = .43, small effect, for ADHD-IA; d = .52, medium effect,
for ADHD-HI; and d = .93, large effect, for ADHD-C) and the ADHD-C group reported more
conflict than the ADHD-IA group (d = .47, small effect).
Together, these two sets of analyses indicate that undergraduate students’ level of ADHD
ADHD AND COLLEGE RELATIONSHIPS 13
symptoms is associated with the three proposed mediators.
Associations of Emotion Regulation Problems, Stress, and Hostile Relationship Conflict
with Relationship Satisfaction
Consistent with hypotheses, for women, all three proposed mediators were negatively
associated with relationship satisfaction (rs = -.26 – -.69, p <.01; see Table 2). However, for
men, only hostile relationship conflict was correlated with lower relationship satisfaction.
Tests of Mediation
Based on the findings presented so far, it was determined that tests of mediation models
could be performed only for women. Although ADHD symptom levels and diagnostic groups
were associated with the three proposed mediators for both men and women equally, neither
ADHD symptoms nor two of the three mediators were associated with men’s relationship
satisfaction. Therefore, for women only, potential mediators of the associations were tested using
a series of regression analyses as outlined by Baron and Kenny.42
Because the simple
associations of ADHD symptoms with all of the proposed mediators and relationship satisfaction
were nearly identical across ADHD symptom type (inattentive, hyperactive-impulsive, and
total), we ran the mediation analyses using only the total symptom score. Findings were
consistent when these analyses were re-run using the separate inattentive and hyperactive-
impulsive scores (not presented here). The resulting mediation models are shown in Figure 1,
using standardized regression coefficients to aid in interpretation. For each model, the
significance of the mediated (i.e., indirect) effect was tested using the product of coefficients
method and with bootstrapping techniques, which is the recommended method for sample sizes
smaller than 400.43
Indirect effects are reported as unstandardized regression coefficients, in the
text.
ADHD AND COLLEGE RELATIONSHIPS 14
Emotion Regulation. When emotion regulation was included in the regression model
predicting relationship satisfaction, the association between ADHD symptoms and satisfaction
was reduced to nonsignificance, indicating mediation (see Figure 1a). As predicted, there was a
negative indirect effect of ADHD symptoms on relationship satisfaction (unstandardized
coefficient = -.14, SE = .08; 95% CI = -.35 to -.02); because zero is not within the confidence
interval, the indirect effect is significant at the p < .05 level.
Perceived Stress. When perceived stress was entered into the regression model
predicting relationship satisfaction, the path from ADHD symptoms to relationship satisfaction
dropped to nonsignificance (see Figure 1b). However, bootstrapping methods failed to find
evidence of mediation; the indirect effect of ADHD symptoms on relationship satisfaction
through perceived stress was not significantly different from zero (unstandardized coefficient = -
.12, SE = .08; 95% CI = -.33 to .01).
Hostile Relationship Conflict. As shown in Figure 1c, when conflict was entered into
the regression model, the association between ADHD symptoms and relationship satisfaction
was reduced to zero. As hypothesized, there was an indirect effect of ADHD symptoms on
relationship satisfaction (unstandardized coefficient = -.39, SE = .14; 95% CI = -.62 to -.08; p <
.01).
Comment
Overall, study findings indicated that college students’ ADHD symptoms may be
associated with less satisfying romantic relationships, although this association differed
somewhat by how ADHD was measured and by gender. First, individuals whose self-reports of
ADHD symptoms were consistent with ADHD-C reported lower relationship satisfaction than
did those classified as having no ADHD (a medium-sized effect, consistent across men and
ADHD AND COLLEGE RELATIONSHIPS 15
women). Second, when ADHD symptom level rather than group classification was examined,
relationship satisfaction was negatively associated with hyperactive-impulsive, inattentive, and
total symptoms, but for women only. The magnitude of this association was small but is
consistent with previous research10
and anecdotal evidence,8 and suggests that young women’s
ADHD symptoms may negatively influence their romantic relationship quality.
As in previous studies, gender did not moderate the associations of relationship
satisfaction with ADHD in this sample. Lower relationship satisfaction associated with the
ADHD-C category was present for both men and women. However, the association between
ADHD symptom level and relationship satisfaction was significant for women only. In fact, with
the exception of hostile relationship conflict, no study variables – including
hyperactive/impulsive symptom levels, inattentive symptom levels, emotional regulation
problems, and stress - were correlated with men’s relationship satisfaction. This pattern of
findings may reflect how college-age men show comparatively lower investment in their
romantic relationships than do women,44
limiting the extent to which romantic relationship
quality is linked to other areas of their lives. Other studies have shown that college men’s
relationship quality is unrelated to personal characteristics such as masculinity, femininity, and
neuroticism, despite significant correlations between these variables observed in college women
and older adult men.45
The present findings suggest that, similarly, college men’s evaluations of
their romantic relationships are not intertwined with their perceived stress, difficulties with
emotion regulation, or ADHD symptom levels. As such, they are consistent with previous
research10
that reported no differences in undergraduate men’s relationship satisfaction by
ADHD status. On the other hand, results from analyses comparing ADHD groups suggested that
both men and women with ADHD-C reported lower relationship satisfaction than the no ADHD
ADHD AND COLLEGE RELATIONSHIPS 16
group. Future research is needed to clarify these associations among men.
In contrast, the findings add to a growing literature documenting associations between
poor relationship functioning and mental health risks among young college women (e.g.,
depressive symptoms14
). In our sample, women’s ADHD symptom levels were negatively
associated with relationship quality. Further, in the female participants, ADHD was associated
with higher levels of emotion regulation difficulties, perceived stress, and hostile relationship
conflict, partially explaining the association between ADHD and relationship satisfaction. These
results replicate previous research documenting associations between ADHD symptoms and
difficulties with emotion regulation27
and extend that research by indicating that emotion
regulation difficulties may be a mechanism through which ADHD symptoms negatively
influence relationship quality for college women. Together with evidence that emotion regulation
mediates the association between ADHD and depressive symptoms,17
these findings highlight
how impaired emotion regulation in ADHD represents a key mechanism through which it may
impair an individual’s functioning.
The current findings also provided strong support for the mediating effect of hostile
relationship conflict. Extending previous findings that children with ADHD show elevated levels
of conflict with parents,20
the present data indicate that young adults, especially women, with
ADHD report heightened conflict with their romantic partners. This suggests that the difficulties
with communication and conflict resolution observed in childhood ADHD may persist into
young adulthood. Further, hostile relationship conflict fully mediated the associations between
emerging adult women’s ADHD symptom levels and relationship quality. Together with
literature documenting hostile conflict as a powerful predictor of couple relationship distress and
break-up,33
the present findings suggest that young adults – especially undergraduate women ‒
ADHD AND COLLEGE RELATIONSHIPS 17
with elevated ADHD symptoms may benefit from healthy relationship programming that
emphasizes constructive communication and conflict resolution skills.46
Limitations
There are some limitations to this study that should be noted. First, while testing for
mediation implies a causal model (i.e., ADHD symptoms cause relationship dissatisfaction), the
correlational nature of the data prohibits conclusions regarding causality. Second, although the
total sample size was sufficient for analysis, the sample of men (n = 73) was somewhat small.
However, given that the association between ADHD symptoms and relationship satisfaction for
men was close to zero (r = .04), it is unlikely that low power led to a failure to detect a true
effect. Third, while the median parental income in our sample was similar to recent national and
regional estimates,47
nearly half of participants reported parental income of $70,000 or above.
Thus, the current findings may not generalize to college students from low-income families.
Finally, we measured ADHD symptoms via a self-report measure and did not collect data
regarding formal ADHD diagnosis or use of prescription medication to treat ADHD symptoms.
Participants who were being successfully treated for ADHD may have reported lower ADHD
symptoms than they would experience without medication; this may have introduced
unaccounted-for error and reduced the power of our analyses. The present findings also do not
speak directly to the relationship satisfaction of undergraduates formally diagnosed with ADHD.
However, over half (56%) of the sample reported clinical levels of ADHD symptoms (>16 on
one or both subscales). This value is much higher than established prevalence rates for ADHD in
young adult college students (2-8%),2 and is consistent with previous studies that have reported
much higher rates of clinical ADHD symptoms than is found in the general population.5,10
Research suggests that college undergraduates are prone to over-report ADHD symptoms on
ADHD AND COLLEGE RELATIONSHIPS 18
self-report measures in both clinical and research contexts,48
and thus the generalizability of the
current findings to clinical ADHD may be limited.
Clinical Implications
Stimulant medication continues to be the most common treatment for ADHD at all
ages,49
and on the whole the literature supports its effectiveness in adults.50
However, no
controlled studies have specifically assessed the effectiveness of medication treatments for
ADHD in college populations.49
Further, those studies that exist suggest that many adults treated
with medication either do not experience significant reduction in ADHD symptoms or
experience intolerable side effects.50
Most of these studies operationalize response to medication
as 30% symptom reduction; thus, even those adults for whom pharmacotherapy is “successful”
often continue to experience considerable impairment related to the core symptoms of ADHD.
Thus, other forms of treatment are needed to augment the limited utility of pharmacotherapy for
some individuals with ADHD. The literature increasingly supports the efficacy of psychosocial
interventions for the treatment of adult ADHD.49
Specifically, research assessing cognitive-
behavioral approaches to treating ADHD in (primarily middle-aged) adults has shown pre-post
effect sizes in the moderate to very large range.49
Preliminary evidence suggests that cognitive-
behavioral approaches are effective for college students as well,51
although the topic remains
understudied.
Clinicians experienced with adult ADHD suggest a key component of successful
psychosocial treatment in this population is to frame interventions within the context of the
client’s most salient distress.52
The present findings, which link ADHD to poor romantic
relationship quality in college undergraduate women, suggest that framing cognitive-behavioral
interventions for ADHD in terms of how they can improve relationship satisfaction may help to
ADHD AND COLLEGE RELATIONSHIPS 19
increase client motivation for and success in treatment. Further, the results of mediation analyses
suggest that poor emotional regulation and elevated hostile couple conflict are potential
intervention targets within such a framework. One possibility is that dialectical behavior therapy
(DBT)25
strategies could be used to target emotion regulation difficulties in young adults with
ADHD, especially those experiencing relationship dysfunction. DBT has received strong
empirical support for a wide and increasing range of psychological and emotional problems,
including both ADHD53
and romantic relationship functioning.54
Mindfulness-based strategies
represent another potential approach, which have been shown to benefit adults with ADHD,49
and to improve abilities in observing and describing inner emotional experience, and being non-
judgmental and non-reactive of one’s emotions.55
These abilities are highly consistent with
emotion regulation skills.56-58
The current finding that hostile relationship conflict fully mediated the association
between ADHD and relationship quality highlights the importance of assessing if and how a
client’s ADHD symptoms might be contributing to negative couple interactions. Relationship
education aimed at building healthy communication and improving conflict resolution skills46
may be a useful strategy for treating comorbid ADHD and romantic relationship dysfunction.
Relationship education can be effectively delivered to individuals, including college students, so
that they can apply the communication and other relationship skills to present and future
relationships.59,60
Further, for those students whose partner would be interested, couple therapy
could be used to teach the couple healthier ways of communicating and also include
psychoeducation about ADHD to help partners understand the individual’s ADHD-related
behaviors.
ADHD AND COLLEGE RELATIONSHIPS 20
Conclusions
The current study adds to the literature by indicating that ADHD symptoms in
undergraduate college students, particularly women, may be associated with lower quality
romantic relationships. Though further study is necessary before confident conclusions can be
drawn, these findings highlight how college students with ADHD may be at risk for poor
outcomes in romantic relationships. The results also provide insight into mechanisms that may
account for this association among women, suggesting potential intervention targets in this
relatively new area of study.
ADHD AND COLLEGE RELATIONSHIPS 21
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ADHD AND COLLEGE RELATIONSHIPS 26
Table 1
Means and Standard Deviations of Variables
Men Women
(n = 73) (n = 116)
Variables M (SD) M (SD)
1. ADHD Hyperactive-Impulsive Symptoms 14.09 (4.89) 14.08 (5.31)
2. ADHD Inattentive Symptoms 16.38 (5.27) 16.13 (5.45)
3. ADHD Total Symptoms 30.49 (8.77) 30.20 (9.57)
4. Relationship Satisfaction 57.92 (16.02) 61.69 (16.13)
5. Emotion Regulation Problems 83.89 (21.09) 82.87 (22.01)
6. Perceived Stress 16.36 (6.15) 18.47 (6.46)
7. Hostile Relationship Conflict 3.20 (1.21) 2.90 (1.15)
ADHD AND COLLEGE RELATIONSHIPS 27
Table 2
Correlations Among Variables
Variables 1 2 3 4 5 6 7
1. ADHD Hyperactivity-Impulsivity -- .50** .85** .04 .48** .30** .27*
2. ADHD Inattentiveness .60** -- .88** .04 .39** .53** .13
3. ADHD Total Symptoms .89** .90** -- .04 .50** .49** .23
4. Relationship Satisfaction -.21* -.21* -.23* -- -.12 -.12 -.43**
5. Emotion Regulation Problems .29** .30** .33** -.31** -- .63** .36**
6. Perceived Stress .32** .31** .35** -.26** .60** -- .31**
7. Hostile Relationship Conflict .32** .28** .33** -.69** .38** .38** --
Note. Correlations for men are reported above the diagonal; women below the diagonal.
*p < .05; **p < .01
ADHD AND COLLEGE RELATIONSHIPS 28
Table 3
Mean Levels of Relationship Satisfaction and Proposed Mediators as a Function of ADHD Type
ADHD Type
Variable
Combined
n = 40
Inatten
n = 43
Hyp-Imp
n = 22
None
n = 84 F p
Relationship Satisfaction 54.30a 60.89
ab 59.50
ab 62.94
b 2.68 .048
Emotion Regulation Problems 95.07a 87.78
ab 84.28
bc 75.06
c 9.88 <.001
Perceived Stress 21.02a 19.80
a 16.70
b 15.20
b 11.08 <.001
Hostile Relationship Conflict 3.62a 3.10
b 3.25
ab 2.62
c 7.83 <.001
Note. Within each row, means not sharing a common superscript letter are significantly different
according to LSD post-hoc analyses (p < .05).
ADHD AND COLLEGE RELATIONSHIPS 29
.33** -.26**Emotion Regulation
ADHD Symptoms Relationship Satisfaction
-.23*
-.15
.35** -.21*Perceived Stress
ADHD Symptoms Relationship Satisfaction
-.23**
-.16
.33** -.69**
.00
ADHD Symptoms Relationship Satisfaction
Hostile Relationship
Conflict
-.23**
a)
b)
c)
ADHD AND COLLEGE RELATIONSHIPS 30
Figure 1. Mediation models for a) emotion regulation, b) perceived stress, and c) hostile
relationship conflict predicting relationship satisfaction. Values are standardized regression
coefficients. Total effects (i.e., unmediated associations between ADHD and relationship
satisfaction) are displayed above the path and direct effects (i.e., the associations between ADHD
and relationship satisfaction when the mediator is included in the model) are shown below the
path. These models are shown for women only. Note: *p < .05; **p < .01.